内容紹介
Summary
A 55-year-old man was diagnosed with rectal cancer invading the urinary bladder and swollen para-aortic lymph nodes. Since distant metastasis was indicated and total pelvic exenteration was required, 6 courses of chemotherapy with mFOLFOX6 plus panitumumab were performed. After the chemotherapy, the rectal cancer and para-aortic lymph nodes significantly decreased in size, and novel distant metastasis was not observed in CT scans. Therefore, the tumor was considered resectable, and operation was performed. Intraoperative frozen section analysis showed that the para-aortic lymph nodes and surgical margin of the urinary bladder were negative. Thus, low anterior resection of the rectum and partial resection of the urinary bladder were performed. R0 resection was pathologically achieved, and adjuvant chemotherapy with S-1 was administered for 6 months. The patient is alive without recurrence for 10 months. Upfront chemotherapy can be a strategy for advanced rectal cancer with urinary bladder invasion to avoid total pelvic exenteration.
要旨
症例は55歳,男性。血便・膿尿・気尿を主訴に前医を受診し,下部消化管内視鏡検査で直腸Raに腫瘍を認め生検で腺癌の診断であった。CT上腫瘍は膀胱・精囊への浸潤を認め,傍大動脈リンパ節も腫脹していた。尿路感染・腸閉塞も呈しており,横行結腸人工肛門造設術後,集学的治療目的に当科紹介となった。化学療法を先行させる方針となりmFOLFOX6+panitumumabを6コース施行したところ,腫瘍は著明に縮小したため手術を企図した。傍大動脈リンパ節の転移陰性を確認後,直腸低位前方切除,膀胱部分切除,左精囊合併切除を施行した。膀胱全摘を回避しつつR0切除が施行できた。病理所見はypT3,ypN0,ypM0,ypStageⅡ,薬物治療効果の組織学的判定はGrade 1bであった。術後はS-1の補助化学療法を6か月行い,術後約10か月後の現在まで無再発生存中である。術前化学療法を行うことで根治性を保ちつつ,機能温存を望める術式を選択できる可能性がある。
目次
A 55-year-old man was diagnosed with rectal cancer invading the urinary bladder and swollen para-aortic lymph nodes. Since distant metastasis was indicated and total pelvic exenteration was required, 6 courses of chemotherapy with mFOLFOX6 plus panitumumab were performed. After the chemotherapy, the rectal cancer and para-aortic lymph nodes significantly decreased in size, and novel distant metastasis was not observed in CT scans. Therefore, the tumor was considered resectable, and operation was performed. Intraoperative frozen section analysis showed that the para-aortic lymph nodes and surgical margin of the urinary bladder were negative. Thus, low anterior resection of the rectum and partial resection of the urinary bladder were performed. R0 resection was pathologically achieved, and adjuvant chemotherapy with S-1 was administered for 6 months. The patient is alive without recurrence for 10 months. Upfront chemotherapy can be a strategy for advanced rectal cancer with urinary bladder invasion to avoid total pelvic exenteration.
要旨
症例は55歳,男性。血便・膿尿・気尿を主訴に前医を受診し,下部消化管内視鏡検査で直腸Raに腫瘍を認め生検で腺癌の診断であった。CT上腫瘍は膀胱・精囊への浸潤を認め,傍大動脈リンパ節も腫脹していた。尿路感染・腸閉塞も呈しており,横行結腸人工肛門造設術後,集学的治療目的に当科紹介となった。化学療法を先行させる方針となりmFOLFOX6+panitumumabを6コース施行したところ,腫瘍は著明に縮小したため手術を企図した。傍大動脈リンパ節の転移陰性を確認後,直腸低位前方切除,膀胱部分切除,左精囊合併切除を施行した。膀胱全摘を回避しつつR0切除が施行できた。病理所見はypT3,ypN0,ypM0,ypStageⅡ,薬物治療効果の組織学的判定はGrade 1bであった。術後はS-1の補助化学療法を6か月行い,術後約10か月後の現在まで無再発生存中である。術前化学療法を行うことで根治性を保ちつつ,機能温存を望める術式を選択できる可能性がある。